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Sultana S, McCarthy CP, Randhawa M, Cao J, Parakh A, Baliyan V. Role of Computed Tomography in Cardiac Electrophysiology. Radiol Clin North Am 2024; 62:489-508. [PMID: 38553182 PMCID: PMC11088717 DOI: 10.1016/j.rcl.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
With the increasing prevalence of arrhythmias, the use of electrophysiology (EP) procedures has increased. Recent advancements in computed tomography (CT) technology have expanded its use in pre-assessments and post-assessments of EP procedures. CT provides high-resolution images, is noninvasive, and is widely available. This article highlights the strengths and weaknesses of cardiac CT in EP.
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Affiliation(s)
- Sadia Sultana
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Cian P McCarthy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Mangun Randhawa
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jinjin Cao
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Anushri Parakh
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Vinit Baliyan
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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2
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Agasthi P, Sridhara S, Rattanawong P, Venepally N, Chao CJ, Ashraf H, Pujari SH, Allam M, Almader-Douglas D, Alla Y, Kumar A, Mookadam F, Packer DL, Holmes DR, Hagler DJ, Fortuin FD, Arsanjani R. Safety and efficacy of balloon angioplasty compared to stent-based-strategies with pulmonary vein stenosis: A systematic review and meta-analysis. World J Cardiol 2023; 15:64-75. [PMID: 36911751 PMCID: PMC9993931 DOI: 10.4330/wjc.v15.i2.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/17/2022] [Accepted: 02/08/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Pulmonary vein stenosis (PVS) is an uncommon but known cause of morbidity and mortality in adults and children and can be managed with percutaneous re-vascularization strategies of pulmonary vein balloon angioplasty (PBA) or pulmonary vein stent implantation (PSI).
AIM To study the safety and efficacy outcomes of PBA vs PSI in all patient categories with PVS.
METHODS We performed a literature search of all studies comparing outcomes of patients evaluated by PBA vs PSI for PVS. We selected all published studies comparing PBA vs PSI for PVS with reported outcomes of restenosis and procedure-related complications in all patient categories. In adults, PVS following atrial fibrillation ablation and in children PVS related to congenital etiology or post-procedural PVS following total or partial anomalous pulmonary venous return repair were included. The patient-centered outcomes were risk of restenosis requiring re-intervention and procedural-related complications. The meta-analysis was performed by computing odds ratios (ORs) using the random effects model based on underlying statistical heterogeneity.
RESULTS Eight observational studies treating 768 severe PVS in 487 patients met our inclusion criteria. The age range of patients was 6 months to 70 years and 67% were males. The primary outcome of the re-stenosis requiring re-intervention occurred in 196 of 325 veins in the PBA group and 111 of 443 veins in the PSI group. Compared to PSI, PBA was associated with a significantly increased risk of re-stenosis (OR 2.91, 95%CI: 1.15-7.37, P = 0.025, I2 = 79.2%). Secondary outcomes of the procedure-related complications occurred in 7 of 122 patients in the PBA group and 6 of 69 in the PSI group. There were no statistically significant differences in the safety outcomes between the two groups (OR: 0.94, 95%CI: 0.23-3.76, P = 0.929), I2 = 0.0%).
CONCLUSION Across all patient categories with PVS, PSI is associated with reduced risk of re-intervention and is as safe as PBA and should be considered first-line therapy for PVS.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Srilekha Sridhara
- Department of Internal Medicine, Banner Heart Hospital, Mesa, AZ 85054, United States
| | - Pattara Rattanawong
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Nithin Venepally
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Hasan Ashraf
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Sai Harika Pujari
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Mohamed Allam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | | | - Yamini Alla
- Department of Medicine, Bronx Lebanon Hospital, Bronx, NY 10457, United States
| | - Amit Kumar
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Douglas L Packer
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - David R Holmes Jr
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Donald J Hagler
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Floyd David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
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3
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Mutluoglu M, Vandenbulcke R, De Smet K. Man with shortness of breath and pulmonary consolidation. J Accid Emerg Med 2022; 39:930-958. [DOI: 10.1136/emermed-2022-212323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2022] [Indexed: 12/26/2022]
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4
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Fink T, Vogler J, Proietti R, Sciacca V, Heeger C, Rottner L, Maurer T, Metzner A, Mathew S, Eitel C, Eitel I, Sohns C, Sano M, Reissmann B, Rillig A, Ouyang F, Kuck K, Tilz RR. Antithrombotic therapy after angioplasty of pulmonary vein stenosis due to atrial fibrillation ablation: A two‐center experience and review of the literature. J Arrhythm 2022; 38:1009-1016. [DOI: 10.1002/joa3.12777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/29/2022] [Accepted: 08/26/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Thomas Fink
- University Heart Centre Lübeck, Section of Electrophysiology University Hospital Schleswig‐Holstein Lübeck Germany
- Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
- Clinic for Electrophysiology, Heart and Diabetes Center North Rhine‐Westphalia Ruhr‐University Bochum Bad Oeynhausen Germany
- Clinic for Electrophysiology, Heart and Diabetes Center North Rhine‐Westphalia Ruhr‐University Bochum Bad Oeynhausen Germany
| | - Julia Vogler
- University Heart Centre Lübeck, Section of Electrophysiology University Hospital Schleswig‐Holstein Lübeck Germany
| | - Riccardo Proietti
- Department of Cardiac, Thoracic, and Vascular Sciences University of Padua Padua Italy
| | - Vanessa Sciacca
- University Heart Centre Lübeck, Section of Electrophysiology University Hospital Schleswig‐Holstein Lübeck Germany
- Clinic for Electrophysiology, Heart and Diabetes Center North Rhine‐Westphalia Ruhr‐University Bochum Bad Oeynhausen Germany
| | - Christian‐Hendrik Heeger
- University Heart Centre Lübeck, Section of Electrophysiology University Hospital Schleswig‐Holstein Lübeck Germany
- Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Laura Rottner
- Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
- Department of Cardiac Electrophysiology, University Heart Center University Hospital Hamburg Eppendorf Hamburg Germany
| | - Tilman Maurer
- Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Andreas Metzner
- Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
- Department of Cardiac Electrophysiology, University Heart Center University Hospital Hamburg Eppendorf Hamburg Germany
| | - Shibu Mathew
- Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
- Department of Cardiology University Hospital of Giessen Giessen Germany
| | - Charlotte Eitel
- University Heart Centre Lübeck, Section of Electrophysiology University Hospital Schleswig‐Holstein Lübeck Germany
| | - Ingo Eitel
- University Heart Centre Lübeck, Department of Cardiology, Angiology, and Intensive Care Medicine University Hospital Schleswig‐Holstein Lübeck Germany
| | - Christian Sohns
- Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
- Clinic for Electrophysiology, Heart and Diabetes Center North Rhine‐Westphalia Ruhr‐University Bochum Bad Oeynhausen Germany
| | - Makoto Sano
- University Heart Centre Lübeck, Section of Electrophysiology University Hospital Schleswig‐Holstein Lübeck Germany
| | - Bruno Reissmann
- Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
- Department of Cardiac Electrophysiology, University Heart Center University Hospital Hamburg Eppendorf Hamburg Germany
| | - Andreas Rillig
- Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
- Department of Cardiac Electrophysiology, University Heart Center University Hospital Hamburg Eppendorf Hamburg Germany
| | - Feifan Ouyang
- Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
- Department of Cardiac Electrophysiology, University Heart Center University Hospital Hamburg Eppendorf Hamburg Germany
| | - Karl‐Heinz Kuck
- University Heart Centre Lübeck, Section of Electrophysiology University Hospital Schleswig‐Holstein Lübeck Germany
- Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Roland Richard Tilz
- University Heart Centre Lübeck, Section of Electrophysiology University Hospital Schleswig‐Holstein Lübeck Germany
- Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
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5
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Patel JD, Mandhani M, Gray R, Pettus J, McCracken CE, Thomas A, Bauser-Heaton H, Kim DW, Petit CJ. Transcatheter Recanalization of Atretic Pulmonary Veins in Infants and Children. Circ Cardiovasc Interv 2022; 15:e011351. [PMID: 35727880 DOI: 10.1161/circinterventions.121.011351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary vein stenosis is a progressive disease associated with a high rate of mortality in children. If left untreated, myofibroblastic proliferation can lead to pulmonary vein atresia (PVA). In our experience, transcatheter recanalization has emerged as a favorable interventional option. We sought to determine the acute success rate of recanalization of atretic pulmonary veins and mid-term outcomes of individual veins after recanalization. METHODS We reviewed all patients with PVA at our institution between 2008 and 2020 diagnosed by either catheterization or cardiac computed tomography. All veins with successful recanalization were reviewed and procedural success rate and patency rate were noted. Competing risk analysis was performed to demonstrate outcomes of individual atretic veins longitudinally. RESULTS Between 2008 and 2020, our institution diagnosed and treated 131 patients with pulmonary vein stenosis. Of these, 61 patients developed atresia of at least one pulmonary vein. In total, there were 97 atretic pulmonary veins within this group. Successful recanalization was accomplished in 47/97 (48.5%) atretic veins. No atretic pulmonary veins were successfully recanalized before 2012. The majority of veins were recanalized between 2017 and 2020-39/56 (70%). The most common intervention after recanalization was drug-eluting stent placement. At 2-year follow-up 42.6% of recanalized veins (20.6% of all atretic veins) remained patent with a median of 4 reinterventions per person. CONCLUSIONS Transcatheter recanalization of PVA can result in successful reestablishment of flow to affected pulmonary veins in many cases. Drug-eluting stent implantation was the most common intervention performed immediately post-recanalization. Vein patency was maintained in 42.6% of patients at 2-year follow-up from recanalization with appropriate surveillance and reintervention. Overall, only a small portion of atretic pulmonary veins underwent successful recanalization with maintained vessel patency at follow-up. Irrespective of successful recanalization, there was no detectable survival difference between the more recently treated PVA cohort and non-PVA cohort.
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Affiliation(s)
- Jay D Patel
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, GA (J.D.P., M.M., R.G., J.P., C.E.M., A.T., H.B.-H., D.W.K., C.J.P.)
| | - Mansi Mandhani
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, GA (J.D.P., M.M., R.G., J.P., C.E.M., A.T., H.B.-H., D.W.K., C.J.P.)
| | - Rosemary Gray
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, GA (J.D.P., M.M., R.G., J.P., C.E.M., A.T., H.B.-H., D.W.K., C.J.P.)
| | - Joelle Pettus
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, GA (J.D.P., M.M., R.G., J.P., C.E.M., A.T., H.B.-H., D.W.K., C.J.P.)
| | - Courtney E McCracken
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, GA (J.D.P., M.M., R.G., J.P., C.E.M., A.T., H.B.-H., D.W.K., C.J.P.)
| | - Amanda Thomas
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, GA (J.D.P., M.M., R.G., J.P., C.E.M., A.T., H.B.-H., D.W.K., C.J.P.)
| | - Holly Bauser-Heaton
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, GA (J.D.P., M.M., R.G., J.P., C.E.M., A.T., H.B.-H., D.W.K., C.J.P.)
| | - Dennis W Kim
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, GA (J.D.P., M.M., R.G., J.P., C.E.M., A.T., H.B.-H., D.W.K., C.J.P.)
| | - Christopher J Petit
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, GA (J.D.P., M.M., R.G., J.P., C.E.M., A.T., H.B.-H., D.W.K., C.J.P.)
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Morgan Stanley Children's Hospital (C.J.P.)
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6
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Salem A, Aly A, Ortiz JF, Cohen RA. Post-ablation Dyspnea a Case Report to Highlight the Differential Diagnoses. Cureus 2021; 13:e17793. [PMID: 34660003 PMCID: PMC8496496 DOI: 10.7759/cureus.17793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/05/2022] Open
Abstract
The diagnosis of post-cardiac ablation pericarditis is difficult as it requires the exclusion of the more common causes of chest pain, but in the right setting, non-invasive diagnostic tools are adequate. Here we present the case of a 60-year-old man who underwent atrial fibrillation ablation and subsequently developed severe mid-sternal chest pain and dyspnea one day later without significant electrocardiographic findings, a mildly elevated troponin T, and elevation of the right hemidiaphragm. The patient was managed conservatively. A two-dimensional transthoracic echocardiogram showed no regional wall motion abnormalities, significant transvalvular gradients, but showed minimal pericardial effusion. A sniff test was negative for diaphragmatic paralysis. After the diagnosis, the patient’s symptoms resolved with non-steroidal anti-inflammatory drugs and colchicine. This case of pericarditis after cardiac ablation highlights the possible differential diagnosis when confronted with post-ablation cardiac symptoms. Despite the classic presentation, the electrocardiogram showed no significant ST/PR changes. In the right clinical setting, non-invasive imaging may be appropriate management.
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Affiliation(s)
- Amr Salem
- Hospital Medicine, Brown University, Providence, USA
| | - Ahmed Aly
- Internal Medicine, Alexandria Faculty of Medicine, Alexandria, EGY
| | - Juan Fernando Ortiz
- Neurology, Universidad San Francisco de Quito, Quito, ECU.,Neurology, Larkin Community Hospital, Miami, USA
| | - Ronny A Cohen
- Cardiology, Woodhull Hospital, New York University (NYU) School of Medicine, New York, USA
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7
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Pulmonary vein occlusion: A delayed complication following radiofrequency ablation for atrial fibrillation. Radiol Case Rep 2021; 16:3666-3671. [PMID: 34630797 PMCID: PMC8493496 DOI: 10.1016/j.radcr.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 11/22/2022] Open
Abstract
This case reports demonstrates the rare but potentially serious complication of pulmonary vein stenosis and subsequent thrombosis diagnosed two years after radiofrequency ablation of the pulmonary veins for atrial fibrillation. Pulmonary vein stenosis can remain asymptomatic until significant occlusion occurs, after which it can present with a variety of symptoms, mimicking a myriad of cardiovascular and pulmonic pathologies. Early diagnosis and treatment rely on consistent follow up using appropriate diagnostic imaging modalities and is paramount in preventing severe complications.
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8
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Humpl T, Fineman J, Qureshi AM. The many faces and outcomes of pulmonary vein stenosis in early childhood. Pediatr Pulmonol 2021; 56:649-655. [PMID: 32506838 DOI: 10.1002/ppul.24848] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 04/22/2020] [Accepted: 05/11/2020] [Indexed: 11/10/2022]
Abstract
Pulmonary vein stenosis is a rare and poorly understood condition causing obstruction of the large pulmonary veins and of blood flow from the lungs to the left atrium. This results in elevated pulmonary venous pressure and pulmonary edema, pulmonary hypertension, potentially cardiac failure, and death. Clinical signs of the disease include failure to thrive, increasingly severe dyspnea, hemoptysis, respiratory difficulty, recurrent respiratory tract infections/pneumonia, cyanosis, and subcostal retractions. On chest radiograph, the most frequent finding is increased interstitial, ground-glass and/or reticular opacity. Transthoracic echocardiography with pulsed Doppler delineates the stenosis, magnetic resonance imaging and multislice computerized tomography are used for further evaluation. Interventional cardiac catherization, surgical techniques, and medical therapies have been used with varying success as treatment options.
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Affiliation(s)
- Tilman Humpl
- Division of Pediatric Intensive Care, University Children's Hospital Berne, Inselspital, Berne, Switzerland
| | - Jeffrey Fineman
- Department of Pediatrics, Pediatric Critical Care University of California, San Francisco, California
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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9
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Ito K, Kato K, Tanaka H. Experience using drug-coated balloon venoplasty for acquired pulmonary vein stenosis after radiofrequency ablation. J Cardiol Cases 2021; 23:3-5. [PMID: 33437330 DOI: 10.1016/j.jccase.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/03/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022] Open
Abstract
Pulmonary vein stenosis is a rare but severe complication of catheter ablation for arterial fibrillation (AF). Symptoms include dyspnea, hemoptysis, recurrent pneumonia, and pulmonary hypertension. We herein discuss a 27-year-old male patient who presented with hemoptysis and dyspnea three months after catheter ablation for AF. Computed tomography demonstrated an occluded left inferior pulmonary vein (LIPV) and left lower lung edema secondary to severe stenosis of the LIPV. The patient underwent treatment, including drug-coated balloon (DCB) venoplasty. Treatment of pulmonary vein stenosis involving percutaneous interventions with balloon angioplasty and stenting carry a high risk of restenosis. DCB therapy may be used to prevent stenosis. <Learning objective: The use of a drug-coated balloon is feasible and may provide good long-term outcomes in acquired pulmonary vein stenosis after radiofrequency ablation.>.
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Affiliation(s)
- Kansuke Ito
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Ken Kato
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Hiroyuki Tanaka
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
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10
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Miyama H, Takatsuki S, Hashimoto K, Yamashita T, Fujisawa T, Katsumata Y, Kimura T, Fukuda K. Anatomical changes in the pulmonary veins and left atrium after cryoballoon ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1289-1294. [PMID: 33058199 DOI: 10.1111/pace.14092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/25/2020] [Accepted: 10/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The anatomical changes in pulmonary veins (PVs) after cryoballoon ablation (CBA) are unclear. We aimed to determine the morphological changes in the PVs and left atrium (LA) along with the predictive factors for clinical PV stenosis. METHODS We analyzed data of 320 PVs from 80 patients who underwent CBA for atrial fibrillation (age: 62 ± 10 years, 59 males). All patients underwent pre- and post-procedural cardiac computed tomography. We defined clinical PV stenosis when the cross-sectional area decreased by more than 50%. RESULTS The average ostial PV area and LA volume decreased significantly after CBA (pre- vs post-CBA; 2.4 ± 1.0 cm2 vs 2.3±1.1 cm2 , P < .001, 75.0 ± 23.2 cm3 vs 70.7 ± 21.9 cm3 , P < .001, respectively). There was a significant correlation between the reduction rates of the PV area and those of LA volume (R = 0.411, P < .001). The larger preoperative PV area and greater reduction in LA volume were associated with advanced PV narrowing. Clinical PV stenosis was observed in six PVs, was more common in females (male vs female; 0.8% vs 4.8%, P = .043), and tended to be more frequent in left PVs (left PVs vs right PVs; 3.1% vs 0.6%: P = .107), irrespective of the LA volume reduction. CONCLUSIONS The significant reduction of the ostial PV area occurred after CBA, which correlated with the reduction rate of LA volume. The narrowing of the PV was partly produced by the LA volume reduction. Clinical PV stenosis was more common in females and tended to be more frequent in left PVs.
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Affiliation(s)
- Hiroshi Miyama
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kenji Hashimoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Terumasa Yamashita
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Taishi Fujisawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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11
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Dalal AR, Markham R, Haeffele C, Sharma R, Watkins AC. Percutaneous Pulmonary Vein Stenting to Treat Severe Pulmonary Vein Stenosis After Surgical Reconstruction. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:382-385. [PMID: 32639846 DOI: 10.1177/1556984520933962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 36-year-old female underwent left lower lobectomy with left atrial and left upper pulmonary vein (LUPV) reconstruction with a bovine pericardial patch for an intrathoracic pheochromocytoma. Postoperatively, she developed shortness of breath and transesophageal echocardiography demonstrated LUPV stenosis with increased velocities. Computed tomography angiogram of the chest revealed LUPV stenosis at the left atrium ostium with an area of 39 mm2. Under angiographic and echocardiographic guidance, a 10 × 19 mm Omnilink Elite uncovered stent was deployed in the LUPV ostia. While reported following left atrial ablation, pulmonary vein stenting can be successful in a pulmonary vein surgically reconstructed with bovine pericardium.
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Affiliation(s)
- Alex R Dalal
- 6429 Department of Cardiothoracic Surgery, Stanford University, CA, USA
| | - Ryan Markham
- 6429 Department of Medicine, Division of Cardiovascular Medicine, Stanford University, CA, USA
| | - Christiane Haeffele
- 6429 Department of Medicine, Division of Cardiovascular Medicine, Stanford University, CA, USA
| | - Rahul Sharma
- 6429 Department of Medicine, Division of Cardiovascular Medicine, Stanford University, CA, USA
| | - A Claire Watkins
- 6429 Department of Cardiothoracic Surgery, Stanford University, CA, USA
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12
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Xuan Z, Liu B, Ci M, Wang Z, Fan Y. Hemoptysis secondary to pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation: A case report and literature review. J Interv Med 2020; 3:98-100. [PMID: 34805916 PMCID: PMC8562220 DOI: 10.1016/j.jimed.2020.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives Pulmonary vein stenosis (PVS) is a known complication after radiofrequency ablation of atrial fibrillation (RAAF) and is often misdiagnosed owing to lack of awareness regarding PVS among noncardiologists. Misdiagnosis results in unnecessary treatment; therefore, greater understanding of PVS can improve the management of these patients. Methods We report the case of a 38-year-old man with a history of RAAF who presented with massive hemoptysis. His symptoms persisted despite undergoing transcatheter bronchial artery embolization on two occasions. Results Pulmonary computed tomography angiography revealed a completely occluded left superior pulmonary vein. Considering the patient’s history of RAAF, we diagnosed him with RAAF-induced PVS and performed left superior lobectomy after which hemoptysis did not recur. Conclusions Unexplained massive hemoptysis should alert clinicians regarding the possibility of RAAF-induced PVS. Balloon angioplasty and stent placement are used to treat PVS; however, their efficacy is controversial considering the high recurrence rates associated with these interventions.
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Affiliation(s)
- Zhiming Xuan
- Tianjin Medical University, Tianjin, Guangdong Road 1, Hexi District, 300202, Tianjin, China
| | - Boyu Liu
- Tianjin Medical University, Tianjin, Guangdong Road 1, Hexi District, 300202, Tianjin, China
| | - Minjun Ci
- Tianjin Medical University, Tianjin, Guangdong Road 1, Hexi District, 300202, Tianjin, China
| | - Zhe Wang
- Department of Radiology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, 300052, Tianjin, China
| | - Yong Fan
- Department of Radiology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, 300052, Tianjin, China
- Corresponding author. Department of Radiology, Tianjin Medical University General Hospital, China.
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13
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Suntharos P, Worley SE, Liu W, Siperstein M, Prieto LR. Long-term outcome of percutaneous intervention for pulmonary vein stenosis after pulmonary vein isolation procedure. Catheter Cardiovasc Interv 2020; 95:389-397. [PMID: 31778024 DOI: 10.1002/ccd.28628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/13/2019] [Accepted: 11/17/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Report long-term outcomes of percutaneous intervention in patients with pulmonary vein stenosis (PVS) after pulmonary vein isolation (PVI) from a single center over 16 years. BACKGROUND Outcome reports of percutaneous intervention for PVS resulting from PVI are limited. METHODS Retrospective review of all patients with PVS after PVI who underwent percutaneous intervention at the Cleveland Clinic Foundation between January 2000 and December 2016. RESULTS A total of 205 patients underwent cardiac catheterization for PVS during the study period. Completely occluded veins which could not be recanalized occurred in six patients. Of the remaining 199 patients, 27 (14%) were lost to follow-up, leaving 172 patients with 276 veins for analysis. Balloon angioplasty was performed in 62 veins and stent implantation in 250 (primary in 214, to treat postdilation restenosis in 36). Re-intervention occurred in 45/62 (73%) balloon-dilated veins and 45/250 (18%) stented veins. Freedom from re-intervention at 1 and 5 years was 90 and 73% following stenting versus 40 and 23% following balloon dilation (p < .001, Hazard ratio (HR) = 5.7). Veins with stent diameter ≥7 mm (n = 231) had greater freedom from re-intervention (95% at 1 year, 79% at 5 years) than veins with stents <7 mm (43% at 1 year, 9% at 5 years), p < .001. There was clear symptomatic improvement after intervention and no procedural mortality. CONCLUSIONS Stent implantation at ≥7 mm for PVS after PVI is associated with low rates of re-intervention, in contrast to balloon dilation and stenting with small conventional stents.
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Affiliation(s)
- Patcharapong Suntharos
- Division of Pediatric Cardiology, Nicklaus Children's Hospital, Miami, Florida.,Department of Pediatric Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sarah E Worley
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Wei Liu
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Marion Siperstein
- Department of Pediatric Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lourdes R Prieto
- Division of Pediatric Cardiology, Nicklaus Children's Hospital, Miami, Florida
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14
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Xu L, Cui L, Hou J, Wang J, Chen B, Xue X, Yang Y, Wu J, Chen J. Clinical characteristics of patients with atrial fibrillation suffering from pulmonary vein stenosis after radiofrequency ablation. J Int Med Res 2019; 48:300060519881555. [PMID: 31709876 PMCID: PMC7610017 DOI: 10.1177/0300060519881555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Pulmonary vein stenosis (PVS) is a serious complication in patients with atrial fibrillation (AF) receiving radiofrequency catheter ablation (RFCA). We therefore examined these patients' clinical characteristics in relation to PVS occurrence. METHOD We retrospectively analyzed the clinical symptoms, diagnostic procedures, and treatment strategies in patients with AF who developed PVS after RFCA. RESULTS Among 205 patients with AF who underwent RFCA, five (2.44%) developed PVS (all men; age 44-64 years; AF history 12-60 months; 2 paroxysmal AF, 3 persistent AF). One patient underwent two RFCA sessions and the others received one. The time to PVS diagnosed by pulmonary vein computed tomography angiography (CTA) was 3 to 21 months. PVS symptoms included dyspnea and hemoptysis. Nine pulmonary veins developed PVS. Single mild PVS occurred in two asymptomatic patients and multiple PVS or single severe PVS in three symptomatic patients who underwent pulmonary vein angiography and stent placement. Symptoms in the three patients significantly improved after stent implantation; however, stent restenosis occurred 1 year later in one case. CONCLUSION PVS is a rare complication of RFCA for AF that can be diagnosed by CTA. Pulmonary vein stent implantation can remarkably improve the symptoms, but stent restenosis may occur.
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Affiliation(s)
- Lingping Xu
- Department of Cardiovascular Medicine, Xianyang Central Hospital, Xianyang, Shaanxi, China.,Department of Ultrasound, Xianyang Central Hospital, Xianyang, Shaanxi, China
| | - Lei Cui
- Department of Ultrasound, Xianyang Central Hospital, Xianyang, Shaanxi, China
| | - Junlong Hou
- Department of Cardiovascular Medicine, Xianyang Central Hospital, Xianyang, Shaanxi, China
| | - Jing Wang
- Department of Cardiovascular Medicine, Xianyang Central Hospital, Xianyang, Shaanxi, China
| | - Bin Chen
- Department of Cardiovascular Medicine, Xianyang Central Hospital, Xianyang, Shaanxi, China
| | - Xianjun Xue
- Department of Cardiovascular Medicine, Xianyang Central Hospital, Xianyang, Shaanxi, China
| | - Ye Yang
- Department of Cardiovascular Medicine, Xianyang Central Hospital, Xianyang, Shaanxi, China
| | - Jine Wu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jianhui Chen
- Department of Cardiovascular Medicine, Xianyang Central Hospital, Xianyang, Shaanxi, China
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15
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Duan Y, Zhou X, Su H, Jiang K, Wu W, Pan X, Qi G, Zhang Y, Cao Y. Balloon angioplasty or stent implantation for pulmonary vein stenosis caused by fibrosing mediastinitis: a systematic review. Cardiovasc Diagn Ther 2019; 9:520-528. [PMID: 31737523 DOI: 10.21037/cdt.2019.09.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Fibrosing mediastinitis (FM) is a very rare disease, often caused by histoplasmosis capsulatum, tuberculosis, sarcoidosis, autoimmunity and other diseases, such as IgG 4-related diseases. Fibrous structures in the mediastinum compress the pulmonary artery, pulmonary vein, superior vena cava, esophagus, trachea and cardiac vessels, leading to clinical symptoms. Drug therapeutic modality for pulmonary vein stenosis (PVS) caused by FM is palliative in essence and with limited efficacy, whereas surgical treatment causes high mortality. In recent years, catheter-based treatment to FM-caused PVS has emerged as a promising therapeutic modality, however, the safety and effectiveness of this modality remain unclear. Therefore, a systematic review on the safety and efficacy of the catheter-based treatment for PVS caused by FM was performed, in the hope to shed lights on the alternative therapeutic strategy to this fatal disease.
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Affiliation(s)
- Yichao Duan
- Clinical Medicine School, Ningxia Medical University, Yinchuan 750004, China.,Department of Cardiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou 730000, China
| | - Xing Zhou
- Department of Radiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou 730000, China
| | - Hongling Su
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou 730000, China
| | - Kaiyu Jiang
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou 730000, China
| | - Wenyu Wu
- Clinical Medicine School, Ningxia Medical University, Yinchuan 750004, China.,Department of Cardiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou 730000, China
| | - Xin Pan
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200000, China
| | - Guanming Qi
- Department of Pulmonary, Tufts Medical Center, Boston, Massachusetts, USA
| | - Yan Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Medical University Eye Hospital, School of Optometry and Ophthalmology & Eye Institute, Tianjin 300384, China
| | - Yunshan Cao
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou University, Lanzhou 730000, China
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16
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Merkulov EV, Sapelnikov OV, Vlasova EE, Nikolaeva OA, Cherkashin DI, Pevzner DV, Gramovich VV, Omarov OM, Saidova MA, Tereshchenko AS, Arutunyan GK, Akchurin RS. [Complications of the Catheter Treatment of Atrial Fibrillation: Stenosis of All Pulmonary Veins after Radiofrequency Ablation]. ACTA ACUST UNITED AC 2019; 59:92-96. [PMID: 31131774 DOI: 10.18087/cardio.2019.5.10260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 05/25/2019] [Indexed: 11/18/2022]
Abstract
Radiofrequency ablation is the "gold standard" in atrial fibrillation treatment. The frequency of complications is about 3.5-3.9 %. The symptomatic pulmonary vein stenosis is one of the most severe complications. In this report we present a clinical case of stenosis of all four pulmonary veins after redo catheter ablation of atrial fibrillation in 61year-old patient, and discussion of possible causes, specific features of diagnosis, and possible approaches to treatment of this complication.
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Affiliation(s)
| | | | - E E Vlasova
- National Medical Research Center for Cardiology
| | | | | | - D V Pevzner
- National Medical Research Center for Cardiology
| | | | - O M Omarov
- National Medical Research Center for Cardiology
| | - M A Saidova
- National Medical Research Center for Cardiology
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17
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Khan A, Qureshi AM, Justino H. Comparison of drug eluting versus bare metal stents for pulmonary vein stenosis in childhood. Catheter Cardiovasc Interv 2019; 94:233-242. [DOI: 10.1002/ccd.28328] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/08/2019] [Accepted: 04/24/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Asra Khan
- Charles E. Mullins Cardiac Catheterization LaboratoriesLillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine Houston Texas
| | - Athar M. Qureshi
- Charles E. Mullins Cardiac Catheterization LaboratoriesLillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine Houston Texas
| | - Henri Justino
- Charles E. Mullins Cardiac Catheterization LaboratoriesLillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine Houston Texas
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18
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Angioplasty Versus Stenting for Pulmonary Vein Stenosis After Radiofrequency Ablation for Atrial Fibrillation-A Systemic Review and Meta-analysis. Am J Ther 2019; 25:e580-e581. [PMID: 30188876 DOI: 10.1097/mjt.0000000000000675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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19
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Walsh K, Marchlinski F. Catheter ablation for atrial fibrillation: current patient selection and outcomes. Expert Rev Cardiovasc Ther 2018; 16:679-692. [DOI: 10.1080/14779072.2018.1510317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Katie Walsh
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of University of Pennsylvania, Philadelphia, PA, USA
| | - Francis Marchlinski
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of University of Pennsylvania, Philadelphia, PA, USA
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20
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Fujii S, Zhou JR, Dhir A. Anesthesia for Cardiac Ablation. J Cardiothorac Vasc Anesth 2018; 32:1892-1910. [DOI: 10.1053/j.jvca.2017.12.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Indexed: 12/19/2022]
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21
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Galizia M, Renapurkar R, Prieto L, Bolen M, Azok J, Lau CT, El-Sherief AH. Radiologic review of acquired pulmonary vein stenosis in adults. Cardiovasc Diagn Ther 2018; 8:387-398. [PMID: 30057885 DOI: 10.21037/cdt.2018.05.05] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Acquired pulmonary vein stenosis (PVS) is an uncommon occurrence in adults, but one that carries significant morbidity/mortality. PVS can be secondary to neoplastic infiltration/extrinsic compression, non-neoplastic infiltration/extrinsic compression, or iatrogenic intervention. This article: (I) reviews the common causes of acquired PVS; (II) illustrates direct and indirect cross-sectional imaging findings in acquired PVS (in order to avoid misinterpretation of these imaging findings); and (III) details the role of imaging before and after the treatment of acquired PVS.
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Affiliation(s)
- Mauricio Galizia
- Division of Thoracic Imaging, Cleveland Clinic, Cleveland, OH, USA.,Division of Thoracic Imaging, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rahul Renapurkar
- Division of Thoracic Imaging, Cleveland Clinic, Cleveland, OH, USA.,Division of Cardiovascular Imaging, Cleveland Clinic, Cleveland, OH, USA
| | - Lourdes Prieto
- Division of Pediatric Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - Michael Bolen
- Division of Thoracic Imaging, Cleveland Clinic, Cleveland, OH, USA.,Division of Cardiovascular Imaging, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph Azok
- Division of Thoracic Imaging, Cleveland Clinic, Cleveland, OH, USA
| | - Charles T Lau
- Division of Thoracic Imaging, Cleveland Clinic, Cleveland, OH, USA.,Division of Thoracic Imaging, Palo Alto Veterans Administration Medical Center, Los Angeles, CA, USA.,Stanford University School of Medicine, Stanford, CA, USA
| | - Ahmed H El-Sherief
- Division of Thoracic Imaging, Cleveland Clinic, Cleveland, OH, USA.,Division of Thoracic Imaging, Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
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22
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Obeso A, Tilve A, Jimenez A, Bonatti J. Spontaneous massive hemothorax presenting as a late complication of stent implantation in a patient with pulmonary vein stenosis following radiofrequency ablation for atrial fibrillation. Interact Cardiovasc Thorac Surg 2018; 26:869-872. [PMID: 29325041 DOI: 10.1093/icvts/ivx380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/01/2017] [Indexed: 11/14/2022] Open
Abstract
Catheter ablation for symptomatic and drug-resistant atrial fibrillation is considered as the main acquired cause of pulmonary vein stenosis in adults. Controversy currently exists about the optimal treatment approach of this entity. Stenting seems to achieve lower vessel restenosis rates than isolated balloon angioplasty. However, these techniques are not exempt from complications. We present a case of spontaneous massive haemothorax presenting as a late complication of stent implantation in a patient with pulmonary vein stenosis.
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Affiliation(s)
- Andres Obeso
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Amara Tilve
- Department of Radiology, Alvaro Cunqueiro Hospital, Vigo, Spain
| | - Alejandro Jimenez
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Johannes Bonatti
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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23
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Balloon angioplasty versus stenting for pulmonary vein stenosis after pulmonary vein isolation for atrial fibrillation: A meta-analysis. Int J Cardiol 2018; 254:146-150. [DOI: 10.1016/j.ijcard.2017.11.100] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/03/2017] [Accepted: 11/26/2017] [Indexed: 11/22/2022]
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24
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Li Y, Meng X, Wang Y, Yang Y, Lu X. Fibrosing mediastinitis with pulmonary hypertension as a complication of pulmonary vein stenosis: A case report and review of the literature. Medicine (Baltimore) 2018; 97:e9694. [PMID: 29369193 PMCID: PMC5794377 DOI: 10.1097/md.0000000000009694] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Fibrosingmediastinitis (FM) is caused by a proliferation of fibrous tissue in the mediastinum encasing the mediastinal viscera that results in compression of mediastinal bronchovascular structures. Pulmonary hypertension (PH) is a severe complication of FM caused by extrinsic compression of pulmonary blood vessels. CASE PRESENTATION Here, we present the case of a 47-year-old man who presented with a 10-year history of progressive hemoptysis and a 2-year history of shortness of breath, in whom a diagnosis of FM was made. Occlusion of the superior pulmonary veins was noted, with stenosis of the inferior pulmonary veins, leading to PH. Because the patient was a poor candidate for interventional catheterization, the preferred treatment for FM, his PH has been managed with diuretics, and he remains stable. CONCLUSIONS FM is a serious, potentially life-threatening condition that is best managed in specialized centers.
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Affiliation(s)
- Yidan Li
- Department of Echocardiography, Heart Center
| | | | - Yidan Wang
- Department of Echocardiography, Heart Center
| | - Yuanhua Yang
- Department of Respiratory and Critical Care Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Xiuzhang Lu
- Department of Echocardiography, Heart Center
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25
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Goldberg JF, Jensen CL, Krishnamurthy R, Varghese NP, Justino H. Pulmonary vein stenosis with collateralization via esophageal varices: Long-term follow-up after successful treatment with drug-eluting stent. CONGENIT HEART DIS 2017; 13:124-130. [DOI: 10.1111/chd.12537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/03/2017] [Accepted: 08/24/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Jason F. Goldberg
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics; Texas Children's Hospital and Baylor College of Medicine; Houston Texas, USA
| | - Craig L. Jensen
- Gastroenterology Section, Department of Pediatrics; Texas Children's Hospital and Baylor College of Medicine; Houston Texas, USA
| | - Rajesh Krishnamurthy
- Department of Radiology; Texas Children's Hospital and Baylor College of Medicine; Houston Texas, USA
| | - Nidhy P. Varghese
- Pulmonary Section, Department of Pediatrics; Texas Children's Hospital and Baylor College of Medicine; Houston Texas, USA
| | - Henri Justino
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics; Texas Children's Hospital and Baylor College of Medicine; Houston Texas, USA
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26
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Housley BC, Bhandary S, Hummel J, Stein E. Acute Pulmonary Hemorrhage Following Radiofrequency Ablation of Atrial Fibrillation. J Cardiothorac Vasc Anesth 2017; 31:1397-1400. [DOI: 10.1053/j.jvca.2017.02.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Indexed: 11/11/2022]
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27
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Role of CT Imaging for Coronary and Non-coronary Interventions. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9410-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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28
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Fender EA, Widmer RJ, Hodge DO, Cooper GM, Monahan KH, Peterson LA, Holmes DR, Packer DL. Severe Pulmonary Vein Stenosis Resulting From Ablation for Atrial Fibrillation. Circulation 2016; 134:1812-1821. [DOI: 10.1161/circulationaha.116.021949] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 10/05/2016] [Indexed: 02/02/2023]
Abstract
Background:
The frequency of pulmonary vein stenosis (PVS) after ablation for atrial fibrillation has decreased, but it remains a highly morbid condition. Although treatment strategies including pulmonary vein dilation and stenting have been described, the long-term impacts of these interventions are unknown. We evaluated the presentation of severe PVS, and examined the risk for restenosis after intervention using either balloon angioplasty (BA) alone or BA with stenting.
Methods:
This was a prospective, observational study of 124 patients with severe PVS evaluated between 2000 and 2014.
Results:
All 124 patients were identified as having severe PVS by computed tomography in 219 veins. One hundred two patients (82%) were symptomatic at diagnosis. The most common symptoms were dyspnea (67%), cough (45%), fatigue (45%), and decreased exercise tolerance (45%). Twenty-seven percent of patients experienced hemoptysis. Ninety-two veins were treated with BA, 86 were treated with stenting, and 41 veins were not treated. A 94% acute procedural success rate was observed and did not differ by initial management. Major procedural complications occurred in 4 of the 113 patients (3.5%) who underwent invasive assessment, and minor complications occurred in 15 patients (13.3%). Overall, 42% of veins developed restenosis including 27% of veins (n=23) treated with stenting and 57% of veins (n=52) treated with BA. The 3-year overall rate of restenosis was 37%, with 49% of BA-treated veins and 25% of stented veins developing restenosis (hazard ratio, 2.77; 95% confidence interval, 1.72–4.45;
P
<0.001). After adjustment for age, CHA2DS2-VASc score, hypertension, and the time period of the study, there was still a significant difference in the risk of restenosis for BA versus stenting (hazard ratio, 2.46; 95% confidence interval, 1.47–4.12;
P
<0.001).
Conclusions:
The diagnosis of PVS is challenging because of nonspecific symptoms and the need for dedicated pulmonary vein imaging. There is no difference in acute success by type of initial intervention; however, stenting significantly reduces the risk of subsequent pulmonary vein restenosis in comparison with BA.
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Affiliation(s)
- Erin A. Fender
- From Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (E.A.F., R.J.W., K.H.M., L.A.P., D.R.H., D.L.P.); and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H., G.M.C.)
| | - R. Jay Widmer
- From Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (E.A.F., R.J.W., K.H.M., L.A.P., D.R.H., D.L.P.); and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H., G.M.C.)
| | - David O. Hodge
- From Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (E.A.F., R.J.W., K.H.M., L.A.P., D.R.H., D.L.P.); and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H., G.M.C.)
| | - George M. Cooper
- From Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (E.A.F., R.J.W., K.H.M., L.A.P., D.R.H., D.L.P.); and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H., G.M.C.)
| | - Kristi H. Monahan
- From Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (E.A.F., R.J.W., K.H.M., L.A.P., D.R.H., D.L.P.); and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H., G.M.C.)
| | - Laurie A. Peterson
- From Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (E.A.F., R.J.W., K.H.M., L.A.P., D.R.H., D.L.P.); and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H., G.M.C.)
| | - David R. Holmes
- From Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (E.A.F., R.J.W., K.H.M., L.A.P., D.R.H., D.L.P.); and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H., G.M.C.)
| | - Douglas L. Packer
- From Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (E.A.F., R.J.W., K.H.M., L.A.P., D.R.H., D.L.P.); and Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL (D.O.H., G.M.C.)
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29
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Pagel PS, Sethi P, Boettcher BT, Dolinski SY. A Pulmonary Venous Blood Flow Problem During Left Upper Lobectomy. J Cardiothorac Vasc Anesth 2016; 30:1156-8. [PMID: 27521974 DOI: 10.1053/j.jvca.2016.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 01/30/2016] [Accepted: 01/30/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Paul S Pagel
- Anesthesia Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
| | - Pawan Sethi
- Anesthesia Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Brent T Boettcher
- Anesthesia Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Sylvia Y Dolinski
- Anesthesia Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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30
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Verma I, Tripathi H, Sikachi RR, Agrawal A. Pulmonary Hypertension due to Radiofrequency Catheter Ablation (RFCA) for Atrial Fibrillation: The Lungs, the Atrium or the Ventricle? Heart Lung Circ 2016; 25:1177-1183. [PMID: 27475259 DOI: 10.1016/j.hlc.2016.05.125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 05/21/2016] [Accepted: 05/31/2016] [Indexed: 01/19/2023]
Abstract
Atrial fibrillation is the most common heart rhythm disorder in United States, characterised by rapid and irregular beating of both the atria resulting in the similar ventricular response. While rate and rhythm control using pharmacological regimens remain the primary management strategies in these patients, radiofrequency catheter ablation (RFCA) is rapidly rising as an alternative modality of treatment. Increase in the incidence of RFCA has shed light on complications associated with this procedure. Pulmonary hypertension (PH) is one of the long-term complications that has been observed postcatheter ablation. There have been multiple mechanisms which have been proposed to explain these elevated pulmonary pressures. These include the involvement of the lungs due to pulmonary vein stenosis, pulmonary vein occlusion and, rarely, pulmonary embolism. Radiofrequency catheter ablation can also lead to scarring of the atrium which can cause left atrial diastolic dysfunction leading to elevated pulmonary pressures. Recently, it was also proposed that elevated pulmonary pressure was related to the unmasking of left ventricular diastolic dysfunction occurring after this procedure. In this article, we review all the mechanisms that are associated with the development of pulmonary hypertension in patients undergoing RCFA for atrial fibrillation and the approach to diagnosis and management of such patients.
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Affiliation(s)
- Isha Verma
- Department of Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA
| | - Hemantkumar Tripathi
- Alvin and Lois Lapidus Cancer Institute, Sinai Hospital of Baltimore, Maryland, USA
| | | | - Abhinav Agrawal
- Department of Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA; Northwell Health - Hofstra Northwell School of Medicine Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, New York, USA.
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31
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Zhang G, Yu H, Chen L, Li Y, Liang Z. Pulmonary veins stenosis after catheter ablation of atrial fibrillation as the cause of haemoptysis: three cases and a literature review. CLINICAL RESPIRATORY JOURNAL 2016; 12:3-9. [PMID: 27216646 DOI: 10.1111/crj.12501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 04/28/2016] [Accepted: 05/13/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Haemoptysis is a common clinical symptom with a complicated aetiology. Patients usually visit pulmonologists initially and are misdiagnosed due to physician ignorance regarding the rare causes of haemoptysis. METHODS We report three cases of haemoptysis due to pulmonary vein stenosis accompanied by catheter ablation for atrial fibrillation and review the related literature. RESULTS The three patients presented haemoptysis and they all had the history of catheter ablation. They received kinds of non-invasive and invasive diagnostic and therapeutic procedures. Finally they were confirmed to have pulmonary vein stenosis by either pulmonary angiography or thorax computed tomography three-dimensional reconstructions. CONCLUSIONS Haemoptysis could be caused by pulmonary vein stenosis secondary to catheter ablation for atrial fibrillation. Doctors should be aware of this rare aetiology.
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Affiliation(s)
- Guoxin Zhang
- Department of Respiration, Tianjin Chest Hospital, Tianjin, China
| | - Hu Yu
- Department of Gynecological Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Liangan Chen
- Department of Respiration, Chinese PLA General Hospital, Beijing, China
| | - Yuechuan Li
- Department of Respiration, Tianjin Chest Hospital, Tianjin, China
| | - Zhixin Liang
- Department of Respiration, Chinese PLA General Hospital, Beijing, China
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Spadaro S, Saturni S, Cadorin D, Colamussi MV, Bertini M, Galeotti R, Cappato R, Ravenna F, Volta CA. An unusual case of acute respiratory failure in a patient with pulmonary veins stenosis late after catheter ablation of atrial fibrillation: a case report and the review of the literature. BMC Pulm Med 2015; 15:128. [PMID: 26499985 PMCID: PMC4620024 DOI: 10.1186/s12890-015-0121-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 10/12/2015] [Indexed: 02/07/2023] Open
Abstract
Background Atrial fibrillation (AF) can be treated with percutaneous catheter ablation procedures into the left atrium. Pulmonary veins stenosis (PV) stenosis is a severe complication of this procedure. Case presentation we report a case of late hemoptysis secondary to severe PV stenosis in a man who underwent AF ablation 9 months before onset of symptoms. He presented four episodes of bleeding and developed an acute respiratory failure (ARF). Parameters of respiratory mechanics and medical investigation did not show any abnormalities. Only computed tomography (CT) angiography showed stenosis of 3 out of 4 native PVs. PV balloon dilatation in all affected PVs and a stent was implanted in 1 of the 3 PVs with full restoration of respiratory function during 1 year follow-up. Conclusion PV stenosis may be the underlying cause of recurrent haemoptysis after AF ablation in the presence of normal respiratory parameters. This diagnosis can be confirmed by means of CT angiography and magnetic resonance imaging can provide accurate localization of stenosis.
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Affiliation(s)
- Savino Spadaro
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive care, University of Ferrara, Via Aldo Moro, 8, Ferrara, 44121, Italy.
| | - Sara Saturni
- Department of Morphology, Surgery and Experimental Medicine, Respiratory Medicine, S.Anna Hospital, Ferrara, Italy.
| | - Delia Cadorin
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive care, University of Ferrara, Via Aldo Moro, 8, Ferrara, 44121, Italy.
| | - Maria V Colamussi
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive care, University of Ferrara, Via Aldo Moro, 8, Ferrara, 44121, Italy.
| | - Matteo Bertini
- Department of Cardiology, S. Anna Hospital, University of Ferrara, Ferrara, Italy.
| | - Roberto Galeotti
- Department of Morphology, Surgery and Experimental Medicine, Vascular and interventional radiology Unit. S. Anna Hospital, Ferrara, Italy.
| | - Riccardo Cappato
- Centro di Ricerca Aritmologia Clinica ed Elettrofisiologia, Milano, Rozzano, Italy.
| | - Franco Ravenna
- Department of Morphology, Surgery and Experimental Medicine, Respiratory Medicine, S.Anna Hospital, Ferrara, Italy.
| | - Carlo A Volta
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive care, University of Ferrara, Via Aldo Moro, 8, Ferrara, 44121, Italy.
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33
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Lu HW, Wei P, Jiang S, Gu SY, Fan LC, Liang S, Ji X, Rajbanshi B, Xu JF. Pulmonary Vein Stenosis Complicating Radiofrequency Catheter Ablation: Five Case Reports and Literature Review. Medicine (Baltimore) 2015; 94:e1346. [PMID: 26313772 PMCID: PMC4602907 DOI: 10.1097/md.0000000000001346] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study is to characterize the clinical manifestations and features of pulmonary vein stenosis (PVS) by retrospectively analyzing clinical data of patients in addition to reviewing the literature simultaneously to improve the understanding of PVS complicating radiofrequency catheter ablation and to provide evidence for early diagnosis and timely treatment.Clinical, imaging, and follow-up data of 5 patients with PVS-complicating radiofrequency catheter ablation were retrospectively analyzed between January 2012 and December 2014 in Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China. Relevant studies previously reported were also reviewed.Three out of 5 patients received pulmonary angiography. The initial symptoms were not specific, presenting chest pain in 3 cases, hemoptysis in 2 cases. The average duration between radiofrequency ablation to the onset of symptoms was 5.8 months. The chest image results were consolidation and pleural effusion mainly. Veins distributed in the left lungs were mostly influenced in 4 patients, and the inferior veins in 3 patients. Cardiac ultrasound examinations showed pulmonary arterial hypertension in 2 patients. Two patients received selective bronchial artery embolization after bronchial artery radiography because of hemoptysis. One patient underwent video-assisted thoracoscopic biopsy because of the suspicion of tumor.PVS is a condition mostly undetected because of its silent manifestations and inconsistent follow-up. The accurate clinical diagnosis is very difficult. A careful review of medical history and follow-up observation may be useful for all the patients who received the radiofrequency catheter ablation to recognize PVS in the early stage.
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Affiliation(s)
- Hai-Wen Lu
- From the Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Catheter-based intervention for pulmonary vein stenosis due to fibrosing mediastinitis: The Mayo Clinic experience. IJC HEART & VASCULATURE 2015; 8:103-107. [PMID: 26925456 PMCID: PMC4765364 DOI: 10.1016/j.ijcha.2015.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Fibrosing mediastinitis (FM) is a rare but fatal disease characterized by an excessive fibrotic reaction in the mediastinum, which can lead to life-threatening stenosis of the pulmonary veins (PV). Catheter-based intervention is currently the only viable option for therapy. However, the current literature on how best to manage these difficult cases, especially in regards to sequential interventions and their potential complications is very limited. Methods We searched through a database of all patients who have undergone PV interventions at the Earl H. Wood Cardiac Catheterization Laboratory in Mayo Clinic, Rochester. From this collection, we selected patients that underwent PV intervention to relieve stenosis secondary to FM. Results Eight patients were identified, with a mean age of 41 years (24–59 years). Five were men, and three were women. Three patients underwent balloon angioplasty alone, and five patients had stents placed. The majority of patients had acute hemodynamic and symptomatic improvement. More than one intervention was required in five patients, four patients had at least one episode of restenosis, and four patients died within four weeks of their first PV intervention. Conclusions We describe the largest reported case series of catheter-based intervention for PV stenosis in FM. Although catheter-based therapy improved hemodynamics, short-term vascular patency, and patient symptoms, the rate of life-threatening complications, restenosis, and mortality associated with these interventions was found to be high. Despite these associated risks, catheter-based intervention is the only palliative option available to improve quality of life in severely symptomatic patients with PV stenosis and FM. Patients with PV stenosis and FM (especially those with bilateral disease) have an overall poor prognosis in spite of undergoing these interventions due to the progressive and recalcitrant nature of the disease. This underscores the need for further innovative approaches to manage this disease.
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35
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Cubeddu RJ, Gulati VK. Simultaneous kissing stent in a patient with severe bifurcation pulmonary vein stenosis. Catheter Cardiovasc Interv 2015; 85:292-6. [PMID: 24905444 DOI: 10.1002/ccd.25562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/25/2014] [Indexed: 11/11/2022]
Abstract
Pulmonary vein stenosis (PVS) is a late and rare complication of pulmonary vein isolation for the treatment of atrial fibrillation. The ideal approach to the management of PVS has not yet been established, however, corrective procedures may include both surgical and percutaneous techniques. We describe the case of a complex bifurcation lesion involving the left superior pulmonary vein. The condition required percutaneous intervention using a modified kissing stent technique with bare metal stents that resulted in an excellent post-operative course, sustained symptomatic relief, and uncomplicated 1-year follow-up. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Roberto J Cubeddu
- Division of Cardiology, Aventura Hospital and Medical Center, Miami, Florida
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36
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Mielczarek M, Ciecwierz D, Sabiniewicz R, Kochanska A, Suchecka J, Gruchala M, Raczak G. The first reported case of pulmonary vein stenosis treated by percutaneous angioplasty with self-apposing drug-eluting stent implantation. Int J Cardiol 2015; 179:13-5. [PMID: 25464394 DOI: 10.1016/j.ijcard.2014.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
Affiliation(s)
| | - Dariusz Ciecwierz
- First Department of Cardiology, Medical University Gdansk, Gdansk, Poland
| | - Robert Sabiniewicz
- Department of Pediatric Cardiology and Congenital Heart Diseases, Medical University Gdansk, Gdansk, Poland
| | - Anna Kochanska
- Department of Cardiology and Electrotherapy, Medical University Gdansk, Gdansk, Poland
| | - Justyna Suchecka
- Department of Cardiology and Electrotherapy, Medical University Gdansk, Gdansk, Poland
| | - Marcin Gruchala
- First Department of Cardiology, Medical University Gdansk, Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University Gdansk, Gdansk, Poland
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Matsumoto T, Kar S. Latest advances in transseptal structural heart interventions-Percutaneous Mitral Valve Repair and Left Atrial Appendage Occlusion. Circ J 2014; 78:1782-90. [PMID: 25017739 DOI: 10.1253/circj.cj-14-0681] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recent advances in structural heart intervention have produced increasing demand for transseptal access, which was first introduced as a diagnostic tool to directly measure left atrial pressure. Transseptal access allows safe and adequate approach to the left atrium and surrounding structures. Percutaneous transcatheter mitral valve repair using the MitraClip device is a safe and less invasive treatment for selected patients with significant mitral regurgitation, who are at high risk for surgery. This is an echocardiographic- and fluoroscopic-guided procedure requiring accurate transseptal access of the left atrium and clipping of the mitral leaflets at the precise location of their malcoaptation. Percutaneous transcatheter closure of the left atrial appendage is another novel procedure that requires transseptal access of the left atrium, followed by closure or ligation of the left atrial appendage. This catheter-based therapy has been shown to be a safe and effective alternative to long-term anticoagulant therapy for the prevention of stroke in patients with atrial fibrillation. In this article, we systematically review these novel structural heart interventions.
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38
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Kumar N, Aksoy I, Pison L, Timmermans C, Maessen J, Crijns H. Management Of Pulmonary Vein Stenosis Following Catheter Ablation Of Atrial Fibrillation. J Atr Fibrillation 2014; 7:1060. [PMID: 27957081 DOI: 10.4022/jafib.1060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/14/2014] [Accepted: 06/11/2014] [Indexed: 01/31/2023]
Abstract
There is limited literature available regarding PV (pulmonary vein) stenosis management. Starting from its incidence, subsequent follow up using imaging technologies to monitor the success and the way of managing different groups pose varied opinions. However, with newer technological advancements and better understanding of mechanism of the atrial fibrillation ablation, the incidence of PV stenosis secondary to catheter ablation is declining. This paper highlights the current trends and future of management of PV stenosis secondary to catheter ablation for atrial fibrillation.
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Affiliation(s)
| | | | | | | | - Jos Maessen
- Department of cardiac surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht,the Netherlands
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39
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Matsumoto T, Zahn EM, Kar S. Percutaneous pulmonary vein stenosis angioplasty complicated by rupture: successful stenting with a polytetrafluoroethylene-covered stent. Catheter Cardiovasc Interv 2014; 83:E292-5. [PMID: 24590687 DOI: 10.1002/ccd.25462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/13/2014] [Accepted: 02/24/2014] [Indexed: 11/07/2022]
Abstract
A 47-year-old-man with prior pulmonary vein (PV) isolation for atrial fibrillation developed progressive shortness of breath and was found to have total occlusion of the left lower and significant stenosis in left upper PV. A ventilation/perfusion scan showed decreased left lung perfusion. Percutaneous PV stenosis angioplasty was complicated by the rupture of left lower PV with pericardial tamponade; successful stenting with a polytetrafluoroethylene-covered stent was performed. Follow-up studies at nine months showed patency of both veins with a normal ventilation perfusion scan. In this article, we will discuss acquired PV stenosis following PV isolation, percutaneous PV intervention, and the literature supporting the procedure.
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Affiliation(s)
- Takashi Matsumoto
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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40
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Rostamian A, Narayan SM, Thomson L, Fishbein M, Siegel RJ. The incidence, diagnosis, and management of pulmonary vein stenosis as a complication of atrial fibrillation ablation. J Interv Card Electrophysiol 2014; 40:63-74. [PMID: 24626996 DOI: 10.1007/s10840-014-9885-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 02/06/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE Pulmonary vein isolation (PVI) during ablation of atrial fibrillation (AF) is associated with pulmonary vein stenosis (PVS). Although the reported incidence of PVS has fallen in recent years, the precise rate of PVS is unknown. Coherent guidelines for screening and treatment of PVS are not established. We reviewed literature to investigate the incidence, diagnosis, and management of PVS as a complication of PVI. METHODS We reviewed 41 manuscripts that described a total of 4,615 subjects (median, 84 subjects/study). RESULTS The incidence of PVS after PVI reported in literature from 1999 to 2004 ranges from 0 to 44% (mean, 6.3%; median, 5.4%), whereas studies after 2004 report an incidence of 0-19% (mean, 2%; median, 3.1%; p < 0.001). PVS symptoms typically occur with reduction of lung perfusion by 20-25%. Variable criteria exist for diagnosis of PVS by magnetic resonance imaging, computed tomography, and perfusion imaging. The restenosis rate for treatment with balloon angioplasty ranges from 30 to 87% (mean, 60%; median, 47%), compared with immediate stenting that ranges from 14 to 57% (mean, 34%; median, 33%). CONCLUSIONS Recent peer-reviewed articles suggest that PVI carries a 3-8% risk of developing PVS, but they likely underestimate the incidence of PVS, as specific screening and diagnostic guidelines are not established. Imaging modalities should be used to screen patients after ablation of AF since early recognition of PVS improves treatment outcomes. Treatment with angioplasty and stent placement can improve symptoms and lung perfusion but the benefit of treatment with immediate stent placement remains controversial. It is critical to maintain a high clinical index of suspicion for PVS in at-risk individuals to ensure timely detection and treatment.
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Affiliation(s)
- Armand Rostamian
- Cardiac Noninvasive Laboratory, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
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41
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Onalan O, Lashevsky I, Hamad A, Crystal E. Nonpharmacologic stroke prevention in atrial fibrillation. Expert Rev Cardiovasc Ther 2014; 3:619-33. [PMID: 16076273 DOI: 10.1586/14779072.3.4.619] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Atrial fibrillation is associated with significant mortality and morbidity. The burden of morbidity in atrial fibrillation is mostly due to stroke, one of the major causes of death and the leading cause of long-term disability. Although highly effective in prevention of thromboembolic stroke, several factors limit utilization of chronic oral anticoagulation therapy. Eradication of atrial fibrillation and restoration of effective atrial contraction by surgical methods, or recently, by percutaneous catheter ablation methods, are two attractive approaches for stroke prophylaxis. Surgical exclusion of the left atrial appendage has generated considerable interest in the past decades and it is now performed routinely during mitral valve surgery in many centers. Recently, minimally invasive and percutaneous methods for the exclusion of left atrial appendage have been introduced. Currently, these approaches are being evaluated in ongoing trials. This review will discuss the current status of nonpharmacologic methods in the prevention of stroke in atrial fibrillation.
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Affiliation(s)
- Orhan Onalan
- Sunnybrook & Women's College Health Sciences Centre, Arrhythmia Services, Division of Cardiology, 2075 Bayview Avenue, B327, Toronto, Ontario, M4N 3M5, Canada.
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42
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Kopp AF, Küttner A, Trabold T, Heuschmid M, Schröder S, Claussen CD. Cardiac and vascular MDCT: thoracic imaging. Eur Radiol 2013; 13 Suppl 5:M73-81. [PMID: 14989614 DOI: 10.1007/s00330-003-2139-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Andreas F Kopp
- Department of Diagnostic Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany.
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43
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Tehrani S, Lipkin D. Angioplasty of acquired pulmonary vein stenosis using covered stent. Catheter Cardiovasc Interv 2013; 82:E617-20. [PMID: 23592594 DOI: 10.1002/ccd.24942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 02/20/2013] [Accepted: 04/07/2013] [Indexed: 11/07/2022]
Abstract
One of the most serious complications post-catheter ablation of atrial fibrillation is the development of pulmonary vein stenosis. Controversy currently exists about the optimal treatment approach. The use of balloons and larger stents (~10 mm) results in more optimal outcome than just balloon angioplasty alone; however, even with stent implantation, recurrent restenosis may occur in 30 to 50% of patients. We report the case of a 28-year-old man who developed recurrent left inferior pulmonary vein stenosis following radiofrequency ablation for atrial fibrillation. This was initially stented with good result but soon after developed restenosis and required balloon angioplasty. Following the third episode of restenosis, stenting of the pulmonary vein was performed using a covered stent. The pulmonary vein has remained patent for the last 5 years.
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Affiliation(s)
- Shana Tehrani
- Department of Cardiology, The Wellington Hospital, St. John's Wood, London, NW8 9LE, UK; Hatter Cardiovascular Institute, Institute of Cardiovascular Research, University College London, London, WC1E 6HX, UK
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44
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Duggal B, Krishnaswamy A, Kapadia S. Relentless pulmonary vein stenosis: A contemporary approach to a recurring problem. Catheter Cardiovasc Interv 2013; 83:811-6. [DOI: 10.1002/ccd.24882] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 02/05/2013] [Accepted: 02/17/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Bhanu Duggal
- Department of Cardiovascular Medicine; Miller Family Heart & Vascular Institute, Cleveland Clinic Main Campus; Cleveland Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine; Miller Family Heart & Vascular Institute, Cleveland Clinic Main Campus; Cleveland Ohio
| | - Samir Kapadia
- Department of Cardiovascular Medicine; Miller Family Heart & Vascular Institute, Cleveland Clinic Main Campus; Cleveland Ohio
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45
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Yan J, Wang C, Du R, Yuan W, Liang Y. Pulmonary vein stenosis and occlusion after radiofrequency Catheter Ablation for atrial fibrillation. Int J Cardiol 2013; 168:e68-71. [PMID: 23890880 DOI: 10.1016/j.ijcard.2013.07.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 07/03/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Jinchuan Yan
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu Province 212001, PR China.
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46
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Hull JH, Menzies-Gow A, Nicholson AG, Mohiaddin RH, Maher TM. Exercise-induced haemoptysis: a thoroughbred cause? Thorax 2013; 68:599-600. [PMID: 23404840 DOI: 10.1136/thoraxjnl-2012-202209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The authors report a novel case of exercise-induced haemoptysis with an unexpected underlying pathology. The report discusses the case and provides a pragmatic overview of the diagnosis and management of the pulmonary vein stenosis.
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Affiliation(s)
- James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.
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47
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Raviele A, Natale A, Calkins H, Camm JA, Cappato R, Ann Chen S, Connolly SJ, Damiano R, DE Ponti R, Edgerton JR, Haïssaguerre M, Hindricks G, Ho SY, Jalife J, Kirchhof P, Kottkamp H, Kuck KH, Marchlinski FE, Packer DL, Pappone C, Prystowsky E, Reddy VK, Themistoclakis S, Verma A, Wilber DJ, Willems S. Venice Chart international consensus document on atrial fibrillation ablation: 2011 update. J Cardiovasc Electrophysiol 2013; 23:890-923. [PMID: 22953789 DOI: 10.1111/j.1540-8167.2012.02381.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Antonio Raviele
- Cardiovascular Department, Arrhythmia Center and Center for Atrial Fibrillation, Dell'Angelo Hospital, Venice-Mestre, Italy.
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48
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Kulkarni A, Inglessis I. Pulmonary Vein Stenting for Atrial Fibrillation Ablation-Induced Pulmonary Vein Stenosis. Interv Cardiol Clin 2013; 2:195-202. [PMID: 28581983 DOI: 10.1016/j.iccl.2012.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pulmonary vein stenosis (PVS) is a known complication of pulmonary vein isolation in the treatment of atrial fibrillation. Patients with PVS can present with a great variety of symptoms. Clinicians should have a low threshold to evaluate for this potentially morbid and treatable condition. PVS can be treated by stenting affected pulmonary veins via transseptal access to the left atrium and use of bare metal biliary stents.
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Affiliation(s)
- Ameya Kulkarni
- Interventional Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ignacio Inglessis
- Interventional Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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PATEL NEILS, PETTERSSON GOSTA, MURAT TUZCU E, KAPADIA SAMIRR. Successful Surgical Repair of Iatrogenic Pulmonary Vein Stenosis. J Cardiovasc Electrophysiol 2012; 23:656-8. [DOI: 10.1111/j.1540-8167.2011.02272.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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50
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Balasubramanian S, Marshall AC, Gauvreau K, Peng LF, Nugent AW, Lock JE, McElhinney DB. Outcomes After Stent Implantation for the Treatment of Congenital and Postoperative Pulmonary Vein Stenosis in Children. Circ Cardiovasc Interv 2012; 5:109-17. [DOI: 10.1161/circinterventions.111.964189] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sowmya Balasubramanian
- From the Department of Cardiology, Children's Hospital Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Harvard Medical School, Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Lucille Packard Children's Hospital at Stanford, Palo Alto, CA (L.F.P.); and the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (A.W.N.)
| | - Audrey C. Marshall
- From the Department of Cardiology, Children's Hospital Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Harvard Medical School, Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Lucille Packard Children's Hospital at Stanford, Palo Alto, CA (L.F.P.); and the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (A.W.N.)
| | - Kimberlee Gauvreau
- From the Department of Cardiology, Children's Hospital Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Harvard Medical School, Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Lucille Packard Children's Hospital at Stanford, Palo Alto, CA (L.F.P.); and the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (A.W.N.)
| | - Lynn F. Peng
- From the Department of Cardiology, Children's Hospital Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Harvard Medical School, Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Lucille Packard Children's Hospital at Stanford, Palo Alto, CA (L.F.P.); and the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (A.W.N.)
| | - Alan W. Nugent
- From the Department of Cardiology, Children's Hospital Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Harvard Medical School, Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Lucille Packard Children's Hospital at Stanford, Palo Alto, CA (L.F.P.); and the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (A.W.N.)
| | - James E. Lock
- From the Department of Cardiology, Children's Hospital Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Harvard Medical School, Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Lucille Packard Children's Hospital at Stanford, Palo Alto, CA (L.F.P.); and the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (A.W.N.)
| | - Doff B. McElhinney
- From the Department of Cardiology, Children's Hospital Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Harvard Medical School, Boston, MA (S.B., A.C.M., K.G., J.E.L., D.B.M.); the Department of Pediatrics, Lucille Packard Children's Hospital at Stanford, Palo Alto, CA (L.F.P.); and the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (A.W.N.)
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